BEUDAMED
    FDA Adverse Event Injury Summary report: N

    IMPLANTIUM

    MDR report key: 2090036 · Received May 4, 2011

    Report

    Report Number
    3005503242-2011-00032
    Event Type
    Injury
    Date Received
    May 4, 2011
    Date of Event
    April 5, 2011
    Report Date
    April 12, 2011
    Manufacturer
    DENTIUM USA
    Product Code
    DZE
    PMA / PMN Number
    K041368
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    DENTIST

    Narratives

    Additional Manufacturer Narrative · 1

    CONCLUSION: BASED ON INSPECTION RESULTS AND THE DHR REVIEW, THE RETURNED PRODUCT HAS BEEN FOUND TO BE WITHIN SPEC. LACK OF OSSEOINTEGRATION IS A KNOWN ADVERSE EFFECT FOR ALL DENTAL IMPLANTS AS STATED IN OUR IFU. THE OVERALL SUCCESS RATE FOR DENTAL IMPLANTS IS ABOUT 95%. THEREFORE, THE IMPLANT FAILURE IS MOST LIKELY DUE TO CAUSES OTHER THAN THE PRODUCT SUCH AS BONE CONDITION.

    Description of Event or Problem · 1

    THE PRODUCT WAS RETURNED AS AN IMPLANT FAILURE BECAUSE OF FAILURE TO OSSEOINTEGRATE AFTER ALMOST 9 MONTHS. BASED ON THE REPORT, THE PT HAD GOOD ORAL HYGIENE AND GOOD BONE CONDITION. TRADITIONAL 2 STAGE SURGERY WAS DONE. FIXTURE WAS BEING PLACED IN TOOTH LOCATION #19. THE PT HAS NO RECORD OF ANY MEDICAL HISTORY. THE IMPLANT WAS REMOVED BECAUSE OF BONE CONDITION. THE DOCTOR INDICATED THAT THE DEVICE WAS NOT RECEIVED DAMAGED OR DEFECTIVE SUCH THAT IT WOULD NOT PERFORM AS INTENDED. THE PT OUTCOME WAS REPORTED AS RECOVERED WITH NO COMPLICATIONS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 IMPLANTIUM ENDOSSEOUS DENTAL IMPLANT DZE DENTIUM USA FX4814WMLC 07K2702

    Patients

    Seq Age Sex Outcome Treatment
    1 35 YR Required Intervention